Yet Collins has proved to be Trump’s worst VA secretary ever; his main goal is faster privatization of the nation’s largest public health care system. The likelihood that he will control the third-largest federal agency budget and second-largest departmental workforce for another two years is not good news for nine million VA patients.

By the time a Democrat potentially replaces Trump in the White House in January 2029, Collins will have diverted far more than $46 billion annually from their direct care budget to a network of 1.7 million private sector providers and four health care companies who administer it. Just two months ago, he awarded new contracts to the latter worth $1 trillion over the next decade (if not canceled or curtailed by a future administration). As a result, industry giants like United Healthcare and Humana will be profiting from further outsourcing of VA care that is costly, unnecessary, and disfavored by veterans themselves.

VA defenders, inside and outside the Beltway, need a damage control agenda, one that will restrain rather than enable further White House attempts to defund and dismantle the United States’ best working model of socialized medicine. Otherwise, more VA staffing and budget cuts, plus facility closings, in the VA’s own system of 1,380 public hospitals and clinics around the country will be happening soon.

Those most motivated to lead the charge against Secretary Collins on Capitol Hill in 2027 are newly elected pro-labor progressives with personal experience in public health care systems, either as patients or family members of patients, caregivers, or administrators.

Thanks to their successful campaigns against MAGA supporters, these VA defenders now include: former Army paratrooper Richard Ojeda in North Carolina; former Marine drill instructor JoAnna Mendoza in Arizona, who has been treated for military sexual trauma at the VA; former Army surgeon Adam Hamawy, a Gaza war critic from New Jersey who once operated on a helicopter pilot injured in Iraq named Tammy Duckworth, now senator from Illinois; and Fred Wellman from Missouri, a West Point graduate who began rallying fellow vets against Trump six years ago through the Lincoln Project.

Last but not least is VA privatization critic Mitchell Berman, “who spent over a decade serving veterans, active duty service members and their families as a VA nurse” — and now represents conservative Republican Paul Ryan’s old district in Wisconsin. All of the above could help energize a House Veterans Affairs Committee, where playing footsie with Collins (and his predecessor in the Biden Administration) has gone on for too long to the detriment of real agency oversight.

On the Senate Veteran Affairs Committee, the Democrats’ defense of our nation’s largest public health care system would be much improved by adding new senators from either Michigan, Maine, and Iowa. Dr Abdul El-Sayed, the just-elected Michigan public health specialist and Medicare for All advocate, would be following in the footsteps of his longtime ally Senator Bernie Sanders.

El-Sayed could be joined by Troy Jackson, the former logger who ousted five-term Senator Susan Collins with Sanders’s support in Maine; as a state legislator, Jackson long championed the cause of Maine National Guard members who suffered Agent Orange exposure during their Vietnam War–era training but were later deemed ineligible for compensation and health care.

In Iowa, newly elected Senator Josh Turek is not only the son of Vietnam veteran but one who suffered birth defects due to his father’s Agent Orange exposure. As a wheelchair athlete, Turek played alongside disabled vets and worked with them in sports rehabilitation programs. He has pledged to “end unnecessary wars that put American lives at risk” and insure that “veterans exposed to toxic substances during their military service get the care and benefits they need.”

A recent report from Democracy Forward by two former VA officials provides plenty of ammo for new members of Congress to use in a long-overdue counteroffensive against Collins. Josh Jacobs, a former VA undersecretary under Joe Biden and Nicole Nedd, a past director of the agency’s national workforce management program, write:

The VA has lost approximately 30,000 employees through attrition, early retirements, deferred resignations, firings, and other departures. These staff had institutional knowledge and skills that cannot be quickly replaced. The staff who remain are bearing an unsustainable burden. Morale has deteriorated, and there is growing evidence that employees feel unable to raise safety concerns without fear of retaliation — a condition linked to more errors and worse patient outcomes.

In their indictment of Collins, entitled “Ready, Fire, Aim,” the authors warn that “the choices being made now by the Trump-Vance administration — at the White House and within VA’s own leadership — will adversely shape veterans’ care for a generation.”

Nobody new or old inside the Beltway — whether in Congress or veterans’ advocacy organizations — will get much done by themselves, without the pressure of grassroots opposition to cuts in VA care and benefits.

Paul Rieckhoff, an Iraq War veteran who helped found Iraq and Afghanistan Veterans of America (IAVA) two decades ago, believes that “both parties are looking for quiet ways to control VA disability spending, which now tops $118 billion a year for 5.1 million disabled veterans.” This fall, Rieckhoff’s new group, Independent Veterans of America (IVA), backed candidates like Navy Veteran and former National Guard member Dan Osborn, who distanced themselves from both major parties. Unfortunately, Osborn suffered a second narrow defeat running as a labor-backed independent candidate for the US Senate from Nebraska.

Rieckhoff fears that “career political operatives” in Washington are still floating “budget options” that include “cutting benefits and raising minimum disability rating thresholds.” To stop these changes, veterans have to “build the media and organizing muscle to mobilize fast when veterans’ benefits are on the line.”

Fortunately, veterans’ groups across the political spectrum had a major victory earlier this year when they blocked the deceptively named “Take Care of America’s Veterans Act” (TACVA). Veterans Service Organizations (VSOs) like the Veterans of Foreign Wars, Disabled American Veterans, and Progressive Veterans of America all sounded the alarm about this Collins-backed bill pushed by Republican House Speaker Mike Johnson.

TACVA would have helped fifty thousand former service members whose careers were cut short due to medical problems collect both their military pensions and VA disability benefits. But as Common Defense Political Director Naveed Shah warned last summer, this multipart bill was heavily booby-trapped. If enacted, hundreds of thousands of other veterans would have been adversely affected.

According to Shah, an Army veteran who served in Iraq, it would have “cut $57 billion from our future tinnitus and sleep apnea claims, tripled the VA home loan fee, allow[ed] disability appeals to be decided in bulk rather than on the merits of each veteran’s record, enable[d] more lay-offs that threaten the quality of VA care, and [laid] the groundwork for handing VA facilities over to private operators.” (Lame-duck Republicans may make a second attempt to pass TACVA before January.)

Veterans for Peace (VFP) has long been the most reliable first responder whenever veterans’ care has been threatened. VFP’s “Save Our VA” campaign has generated thousands of letters to members of Congress about privatization-related problems, too often downplayed or ignored by VSOs that take health care industry donations. VFP members have personally lobbied many members of Congress or their staffers on VA issues.

A newer Common Defense (CD) campaign — called “VA Not for Sale” — has sponsored VA-focused lobby days in Washington, DC, and town hall meetings in Iowa, Wisconsin, Illinois, and other states. CD and the Veterans Healthcare Policy Institute (VHPI) also collaborated on a just-issued report called “The Privatization Playbook,” which documents the sorry history of bipartisan support for costly and unnecessary VA outsourcing since 2014.

In California, members of the Vietnam Veterans of America (VVA) and VFP have joined forces with active and retired VA caregivers to conduct weekly anti-privatization picketing and rallies at their local facility in Sonoma County.

In 2027, there should be hundreds of events like this, in far more locations across the country. And before it’s too late, more protests should target the costly and defective overhaul of VA medical recordkeeping that’s occurring on Collins’s watch.

As Ace Allen, a now retired VA medical oncologist, warned last spring in The Kansas City Star, in every place where the VA’s existing system has been “modernized” by health information-technology corporation Oracle Health, the result has been serious disruption of patient record handling and widespread demoralization among VA caregivers forced to use an inferior system. As a result, “huge numbers have quit or retired early.”

During the president’s first term, Trump’s son-in-law Jared Kushner helped Oracle (formerly Cerner Corporation) get a no-bid contract to replace what Allen calls a “custom built, publicly owned electronic health record (EHR) system that was refined over decades by VA clinician-coder teams to support clinical care, not maximize revenue.”

A contract originally estimated to cost $10 billion has now ballooned to $32 billion in the same “cost-overrun” fashion as infamous Pentagon projects like the F-35 Joint Strike Fighter. That’s why Steve Friday, an Air Force veteran, VFP member, and former VA social worker in Michigan, is helping to rally foes of Oracle around the country through StopTheRollout.org. According to Friday, this grassroots initiative “brings together clinicians, VA employees, veterans, advocates, union members, and others who understand what is happening and are willing to act.”

They are scouring contracting records, publicizing inspector general and Government Accountability Office reports on Oracle system failures and sharing whistleblower information from patients and providers with members of Congress willing to hold Collins responsible for already occurring patient safety threats.

As Friday explains his involvement and the stakes of the fight for everyone: “the VA, for all its problems, still demonstrates that we can publicly fund and deliver health care rather than turning every patient into a source of profit. Losing that,” he says, “would hurt veterans, workers, and the larger struggle for health care as a human right.” Thanks to last week’s midterm election results, this caregiver perspective will soon be much better reflected on Capitol Hill.